Provider Demographics
NPI:1922354026
Name:PRINCE, MONIQUE MARIE
Entity Type:Individual
Prefix:MS
First Name:MONIQUE
Middle Name:MARIE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MONIQUE
Other - Middle Name:MARIE
Other - Last Name:PRINCE-SPEIGHTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11640 US HIGHWAY 87 N
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:TX
Mailing Address - Zip Code:76934-7000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11640 US HIGHWAY 87 N
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:TX
Practice Address - Zip Code:76934-7000
Practice Address - Country:US
Practice Address - Phone:325-465-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health